Bevacizumab and Carmustine in Treating Patients With Relapsed or Progressive High-Grade Glioma

OBJECTIVES:

Primary

• To determine the 6-month progression-free survival of patients with relapsed or progressive high-grade gliomas treated with bevacizumab and carmustine.

Secondary

• To evaluate the radiographic response to this regimen as measured by MRI and PET scan with image fusion.
• To utilize novel brain imaging to differentiate between a radiographic response due to tumor shrinkage and a radiographic response due to decreased vasogenic edema.
• To evaluate the safety and toxicity of this regimen in these patients.
• To evaluate the overall survival of these patients.

OUTLINE: Patients receive bevacizumab IV on days -7, 8, 22, 36, and 50 of course 1 and on days 8, 22, 36, and 50 of all subsequent courses. Patients also receive carmustine IV over 4 hours on day 1. Treatment repeats every 56 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.

After completion of study therapy, patients are followed every 3 months.

Inclusion criteria

• Histologically confirmed GBM, anaplastic astrocytoma, anaplastic oligoastrocytoma or anaplastic oligodendroglioma.
• Disease progression (confirmed by MRI, PET or both) after radiation therapy
• At least 28 days have elapsed since chemotherapy, major surgery or radiation therapy.
• No other malignancy within 3 years except for non-melanomatous skin cancer or in situ cervical cancer.
• Karnofsky performance score at least 70
• Platelet count ≥ 130/mm3.
• Absolute neutrophil count ≥ 1500/mm3
• Calculated creatinine clearance greater than 45 mg/dl
• AST < 2 times the upper limit of normal
• Bilirubin < 1.5 times the upper limit of normal
• Ability to give signed informed consent
• Patients must be 18 years of age or older.

Exclusion criteria

• Prior intravenous or oral nitrosoureas (BCNU, CCNU) or prior VEGF targeted therapy including bevacizumab. No more than two prior chemotherapy regimens are allowed. Prior or current steroid use is allowed.
• Evidence of CNS hemorrhage
• Requirement for therapeutic anticoagulation
• Any grade 3 or greater hemorrhage within the previous 28 days
• Active inflammatory bowel disease
• Inadequately controlled hypertension
• Any prior history of hypertensive crisis or hypertensive encephalopathy
• New York Heart Association Grade II or greater congestive heart failure
• History of myocardial infarction or unstable angina within 6 months prior to study enrollment
• History of stroke or transient ischemic attack within 6 months prior to study enrollment
• Significant vascular disease
• Symptomatic peripheral vascular disease
• Evidence of bleeding diathesis or coagulopathy
• Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to study enrollment or anticipation of need for major surgical procedure during the course of the study
• Core biopsy or other minor surgical procedure, excluding placement of a vascular access device, within 7 days prior to study enrollment
• History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 6 months prior to study enrollment
• Serious, non-healing wound, ulcer, or bone fracture
• Proteinuria at screening
• Pregnant (or lactating). Use of effective means of contraception in subjects of child-bearing potential
• Prior organ transplantation
• Known hypersensitivity to Chinese hamster ovary cell products or other recombinant human antibodies
• Known acquired immune deficiency syndrome (AIDS) or HIV positive status